Rectified problems concerning coverage/billing to ensure pharmacy needs were properly met for patient/facility.
Verified patient eligibility, coverage and claim status with insurance carrier.
Trained new hires on system/programs/position requirements until full understanding of all processes.
Obtained prior authorizations for coverage on patient\'s medications.
Managed collection against estate of deceased patient.
Evaluated financial status to appropriately set payment plans for patient.
Treated patients, family members, pharmacy/facility staff and carrier reps with courteous, professional manner.
Offered detailed explanation of plan coverage/processes, above job description, to provide excellent customer service.
Acknowledged by management; received customer appreciation regularly.
Awarded multiple times for excellent customer service.
Medical Billing and Coding Specialist with 7 years experience. Strong ability to identify denied/under paid claim items needing appeal/correct claim. Organized professional able to adapt to changes within the Billing and Coding profession. Knowledge and experience to interpret contract language between provider/carrier.
Education, Training and broad knowledge of ICD-9/ICD-10, CPT procedure coding, Revenue codes, Condition codes, DRG assignments, Medicare PC pricers
Inpatient and outpatient coding proficiency
Experience with Traditional Medicare, Medicare Advantage, Commercial, RX coverage plans
HCPCS Coding Guidelines
Composed and professional demeanor with excellent customer service skills
Billing and collection procedures experience
DRG assignment, PC Medicare pricer training, including outpatient grouping and codes
Medical terminology knowledge, ability to read and understand medical records, interpret contract language
Medical Claims and Billing degree : 2009 U.S. Career Institute -